Dr vineet vinayak

1. INTRODUCTION
An interappointment flare-up is an unhappy
event. After a root canal treatment appointment,
the patient calls or returns to the dentist's office
in distress. This is upsetting to both the patient
and the dentist and is disruptive to a busy
practice.

2. • DEFINITION - According to American
Association Of Endodontists, An Endodontic
Flare-Up can be defined as an acute
exacerbation of radicular pathosis after
initiation or continuation of root canal therapy

3. PREVENTION
• Many approaches and techniques to reduce the
severity and incidence of post-treatment pain and flare
ups have been attempted. Some of these involve
complete debridement, multiple visit strategies, and
administration of therapeutic agents. Other possible
preventive strategies have included use of intracranial
medicaments and reducing the occlusion. The
therapeutic measures include the prescribing of
antibiotics or anti-inflammatories (steroids or non-
steroidal anti-inflammatory drugs) or administering
analgesics. Each of these above approaches will be
reviewed as to evidence of effectiveness on decreasing
the incidence of flare-ups.

4. TREATMENT
• Psychological management The patient is predictably and understandably upset
and shaken by the sudden episode of pain or swelling. Reassurance is a critical,
perhaps the most important, aspect of treatment. The patient is concerned and
may even assume that treatment has failed and that extraction is needed. The
dentist must explain that flare-ups do occur and are treatable. Next, the patient
must be made comfortable by breaking the pain cycle. Vital pulp Flare-ups seldom
occur in these situations, but when they do, the problem likely is related to tissue
remnants that have become inflamed. Working lengths should be verified and the
canals carefully cleaned with copious irrigation. A dry cotton pellet is then placed
followed by a temporary restoration. The pain will usually subside rather quickly
and predictably. Necrotic pulp with no swelling These teeth may develop an acute
apical abscess (flare-up) after the appointment. The abscess is confined to bone
and is generally very painful. The patient may have been asymptomatic (seldom)
or symptomatic (usual) at the presenting appointment. At the flare-up emergency
appointment, the same treatment procedure is followed. The tooth is opened and
the canal is instrumented and irrigated with sodium hypochlorite. Occasionally,
drainage will be established through the tooth. This drainage should be allowed to
continue until it ceases. Then the canals are re-irrigated, dried, calcium hydroxide
paste is placed and the access sealed. The tooth should not be left open to the oral
cavity. Interestingly, it was recently reported that drainage from the tooth did not
result in significant reductions in 14 pain as compared to no drainage. In both
situations, symptoms required a few days to subside. If there is no drainage, the
canals should be re-debrided, irrigated, medicated and closed. There 15 seems to
be little benefit in apical trephination.

5. CONCLUSION
• The event of an endodontic flare up presents the
dentist with the patient in severe pain who
requires immediate management. The present
article discusses possible treatment modalities to
combat this unfortunate endodontic emergency.
The art and science of endodontic diagnosis and
treatment have undergone a tremendous
scientific and technological evolution. As a result
the dental profession is prepared and able to
remedy one of the most painful and feared
afficition with compassion, knowledge and skill.